More than half of people who receive Medicare opt for Medicare Advantage (Part C) over Original Medicare (Part A and Part B).

The two aren’t interchangeable, though.

Whereas benefits through Original Medicare are provided by the federal government, Medicare Advantage is offered by a private insurer. So even though you’ll still receive Medicare Part A and B services through a Medicare Advantage plan, other aspects of your coverage may be different.

Ultimately, the best plan for you may depend on which healthcare services you want to receive and which doctors you want to see.

How Does Medicare Advantage Work?

With Medicare Advantage, your coverage comes through a private insurance company rather than the federal government. If you choose a Medicare Advantage plan, Medicare pays a fixed amount to your insurance company each month.

Medicare Advantage plans bundle Medicare Parts A and B and typically include additional benefits such as:

Prescription drug coverage (Part D)
Vision and hearing care
Dental services
Other “extras” (for example, fitness memberships)

While all Medicare Advantage plans have been approved by Medicare — and must offer the same rights and protections as Original Medicare — they can charge different out-of-pocket costs, require you to use a specific network of healthcare providers, and set different rules for how you get certain services. (For example, you may need a referral before your insurance company will cover the cost of a specialist visit.)

Are There Different Types of Medicare Advantage?

There are two main types of Medicare Advantage plans:

Health Maintenance Organizations (HMOs) These plans mainly require you to stay within the plan's network of providers. If you have an HMO, you’ll usually need a primary care doctor and will need a referral to see a specialist.
Preferred Provider Organizations (PPOs) These plans have in-network providers and services, but also tend to cover some out-of-network providers and services (though your costs can be higher). If you have a PPO, you don’t need to have a primary care doctor or obtain a referral to see a specialist.

How Much Does Medicare Advantage Cost?

About 75 percent of people who are enrolled in Medicare Advantage plans that also have prescription drug coverage only pay the required Medicare Part B premium. In 2025, that amount is $185 per month.

About 25 percent of people who have Medicare Advantage pay a supplemental premium, according to recent statistics, usually between $20 and $49 per month. Only about 3 percent of people pay $100 or more in supplemental premiums per month.

Other costs, such as copays and coinsurance, can vary by plan. Unlike Original Medicare, Medicare Advantage caps your annual spending at $9,350 for medical services and $2,000 for prescriptions.

Is Medicare Advantage Different From — or Better Than — Regular Medicare?

Medicare Advantage plans certainly differ from Original Medicare plans, but the answer of whether they’re better can vary from person to person.

While all Medicare Advantage plans must match or exceed Original Medicare’s coverage — of note, they tend to offer drug coverage, vision and hearing benefits, as well as extra perks, such as fitness memberships — there are also some possible drawbacks.

Medicare Advantage plans often require advance approval for many procedures and have a more limited network of providers than Original Medicare, so they may not be right for everyone — particularly people who want to see specific doctors or go to a certain hospital or care center. They also require you to live within the plan’s service area, so if you live in two different areas of the country throughout the year, you’ll want to stick with Original Medicare.

“The network of physicians and hospitals is much more regional than Medicare's national network,” says Josh Hodges, chief customer officer at the National Council on Aging. “It’s important to verify that your preferred doctors and hospitals are in the plan’s network.”

In general, though, research finds that people who have both Original Medicare and Medicare Advantage tend to be equally satisfied with their care. While people on Medicare Advantage may have easier access to preventive care services such as vaccinations and routine checkups, people on Original Medicare had an easier time receiving care in the highest-rated hospitals for cancer care or highest-quality skilled nursing facilities.

“If you’re relatively healthy, a Medicare Advantage plan might make financial sense,” says Jennifer Wolff, PhD, of Johns Hopkins Bloomberg School of Public Health in Baltimore. “But if you’re managing chronic conditions and need specialty care, the wider provider network in original Medicare can become crucial to your decision-making.”

If you choose a Medicare Advantage plan and later decide to disenroll and select Original Medicare, you’re not guaranteed a right to buy a Medigap plan (except in limited situations), as is the case when you are first eligible for Medicare.

Here’s a further breakdown of some similarities and differences between the two:

Providers

You can go to the vast majority of doctors or hospitals in the U.S.

You can only use the doctors or providers within the plan’s network (for non-emergency care).

Referral

In most cases, you don’t need a referral to use a specialist.

You may need to get a referral to use a specialist.

Prior authorization

In most cases, you don’t need prior authorization for services.

In many cases, you do need prior authorization for services.

Costs

You pay coinsurance — usually 20 percent of the Medicare-approved amount for Part B-covered services.

Out-of-pocket costs vary

Premium

You pay a monthly premium for Part B

You pay a monthly premium for Part B and may have to pay a separate plan premium (though most plans have a $0 premium)

Yearly limit

There’s no yearly limit on out-of-pocket costs (though you can buy supplemental coverage such as Medigap).

There’s a yearly limit on what you must pay for covered Part A and Part B services.

Drug coverage

There’s no prescription drug coverage, though you can buy a separate Medicare Part D plan.

Most plans offer Medicare Part D.

Vision and dental benefits

Doesn’t cover most vision or dental costs

May cover some vision and dental

Do I Need Medicare Advantage?

You don’t have to use Medicare Advantage, especially if you have Original Medicare and you’re happy with your plan.

Medicare Advantage plans often attract people with their extra benefits, but they come with some caveats. “Advantage plans often offer benefits like vision, dental, fitness, transportation, and hearing that original Medicare doesn’t cover, which appeal to enrollees,” says Hodges. “But many report this coverage is not as comprehensive as they were expecting.” (And still other people may decide to skip that gym after all.) In fact, about 1 in 3 people on Medicare Advantage say they never ended up utilizing any of the extra benefits their plan offered.

There's another factor to consider: Licensed Medicare brokers earn an incentive when they sign people up for Medicare Advantage plans. In 2025, they can earn a maximum of $626 for initial Medicare Advantage plan enrollment and $313 for renewals; since brokers don’t sell Original Medicare, there is no commission.

That, of course, doesn’t mean a broker is acting against your interests. However, Hodges suggests following these steps to determine which, if any, Medicare Advantage plan is right for you:

Contact your local State Health Insurance Assistance Program (SHIP) for free, unbiased counseling to compare plans that best meet your needs and budget.
Check the star ratings for each Medicare Advantage plan on Medicare’s Plan Finder tool (or call 1-800-MEDICARE). These ratings are based on factors such as customer satisfaction, quality of care, and health outcomes.
Call the plan directly to ask specific questions about anything that’s not clear. Do not sign up until you are satisfied with the answers.
Review your plan annually during the Annual Enrollment Period (October 15 to December 7) and Medicare Advantage Open Enrollment Period (January 1 to March 31).

Where and How Do I Sign Up?

You need to be enrolled in both Medicare Parts A and B before you can join a Medicare Advantage plan. You can only join during these periods:

Initial Coverage Election Period This seven-month window of time is your first opportunity to sign up for Medicare when you first become eligible for it. It typically starts three months before the month you turn 65, includes the month of your birthday, and ends three months after your birthday. This is also when you can first sign up for a Medicare Advantage plan.
Annual Enrollment Period Each year from October 15 to December 7, you can join, switch, or drop a Medicare Advantage plan. Your coverage will begin January 1 of the following year.
If You Get Medicare Due to Disability You can sign up for a Medicare Advantage plan during the period starting 21 months after you receive Social Security or Railroad Retirement Board disability benefits, but your coverage won’t start until your 25th month on disability benefits. Your chance to join lasts through the 28th month after you start receiving these benefits.

How to Enroll

Visit Medicare.gov to compare and join plans.
Call 1-800-MEDICARE (1-800-633-4227).
Contact the plan directly.
Work with a licensed insurance agent.

The Takeaway

Medicare Advantage combines hospital, medical, and usually prescription drug coverage into one plan, with most offering additional benefits not covered by Original Medicare.
While Medicare Advantage plans offer some extra benefits, they tend to have less flexibility in choosing healthcare providers and require prior authorization for many services.
Medicare Advantage plans have an annual out-of-pocket maximum, providing financial protection that Original Medicare doesn’t offer on its own.
Free educational assistance is available through your State Health Insurance Assistance Program (SHIP); they can help you find the best fit for your needs.

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Resources

Medicare Advantage in 2024: Enrollment Update and Key Trends. KFF. August 8, 2024.
Medicare Advantage: What Is It and How Does It Work? National Council on Aging. April 28, 2025.
Understanding Medicare Advantage Plans. Medicare.gov.
Who’s Eligible for Medicare? U.S. Department of Health and Human Services. December 8, 2022.
Compare Types of Medicare Advantage Plans. Medicare.gov.
What You'll Pay in Out-of-Pocket Medicare Costs in 2025. National Council on Aging. May 1, 2025.
Freed M et al. Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization. KFF. August 8, 2024.
Ochieng N et al. Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature. KFF. September 16, 2022.
Get Ready to Buy. Medicare.gov.
What Do Medicare Beneficiaries Value About Their Coverage? The Commonwealth Fund. February 22, 2024.
Tabor L et al. Background: Medicare Insurance Agents. Medpac. March 6, 2025.
Understanding Medicare Advantage & Medicare Drug Plan Enrollment Periods. Medicare.gov. April 2025.

Sarah Goodell, MA

Reviewer

Sarah Goodell is a health policy consultant with over 25 years of experience. She is currently working as an independent consultant focusing on the Affordable Care Act, Medicare, health financing, and health delivery systems.

She previously served as director of the Synthesis Project, funded by the Robert Wood Johnson Foundation. At the Synthesis Project she managed projects on a variety of topics, including risk adjustment, Medicaid managed care, hospital consolidation, the primary care workforce, care management, and medical malpractice.

Prior to her work as a consultant, Ms. Goodell spent five years as a policy analyst in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services. Her work at ASPE focused on private insurance and patient protections, including external appeals processes and privacy.

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Holly Pevzner

Author

Holly Pevzner is a writer who specializes in health, nutrition, parenting, and pregnancy. She is currently a staff writer at Happiest Baby. Her work, including essays, columns, features, and more, spans a variety of publications, websites, and brands, such as EatingWell, Family Circle, Fisher-Price, Parents, Real Simple, and The Bump. Pevzner has written several monthly health columns, including for First for Women and Prevention magazines. She previously held senior staff positions at Prevention, Fitness, and Self magazines, covering medical health and psychology. She was also a contributing editor at Scholastic's Parent & Child magazine.

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